Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Monday, September 03, 2007

A Bit of Representativeness, Accountability and Transparency in Academic Governance Threatened

In the opinion section of the Wall Street Journal (and available free here from OpinionJournal) was an interesting article about the governance of US higher education, with some lessons for academic health care.

The story is about Dartmouth College, an Ivy League school, and home of a small, but distinguished medical school. Dartmouth has an unusual way of picking the members of its board of trustees.

It is one of a few schools in the U.S. that allow alumni to elect leaders directly. Eight of the 18 members of Dartmouth's governing Board of Trustees are chosen by the popular vote of some 66,500 graduates. (The other seats are reserved mostly for major donors, along with ex officio positions for the governor of New Hampshire and the college president.) This arrangement has been in place since 1891.

Recently, this has lead to an interesting change in the membership of the board.

Until recently, though, Dartmouth's elections have been indifferent affairs, with the alumni choosing from a largely homogeneous slate handpicked by a committee closely aligned with the administration. In 2004, things got--interesting. Mr. [Thurman J] Rodgers [Founder and CEO of Cypress Semiconductor Corp] bypassed the official nomination channels and was named to the ballot by collecting alumni signatures; he needed 500 and ended up acquiring more than 15 times that. He was dissatisfied with the college's direction and resolved to either 'do something or stop griping about it.' He was elected by 54% of the voters.

Since Mr Rogers' election, three more candidates have been elected to the board after nomination by alumni petition.

Mr. Rodgers's candidacy was followed by two further elections, in which petition candidates--Peter Robinson, a fellow at the Hoover Institution, and Todd Zywicki, a professor of law at George Mason University--were also elected.

Earlier this year another petition trustee, Stephen Smith of the University of Virginia Law School, was elected with 55% of the voters.

All petition candidates were known as dissidents or reformers. As Rogers put it, they are "independent people willing to challenge the status quo."

Thus, the composition of Dartmouth's board of trustees is very different from that of most major American universities. Most university boards pick their new members themselves. Some do allow for alumni membership of a few members, but the candidates for such positions are generally hand-picked by the board or an administration committee, and rarely advertise their policy positions. Thus, the key governing bodies of most US institutions of higher education, and hence the key governing bodies to which most US medical schools (other than the Dartmouth Medical School) report are self-elected.

The atypical members of the Dartmouth board have tried to reform how the institution runs. For example, Mr Rodgers' "first priority was to improve its 'very poor record of freedom of speech.' Soon enough, the college president, James Wright, overturned a speech code. The Foundation for Individual Rights in Education, a watchdog group, elevated Dartmouth's rating from 'red' to its highest, 'green,' one of only seven schools in the country with that status. 'We made progress, and I was feeling pretty good,' Mr. Rodgers says."

This was notable because, as we have discussed on Health Care Renewal, academic institutions, and academic medicine in particular, have not always had stellar records of defending their students' and faculties' right to say or write controversial things, especially those that offend vested interests. In particular, academic medical institutions have:

Gone along with attempts to suppress medical research that offended vested interests. (See posts here and here.)

Allowed research contracts with commercial sponsors that allowed those sponsors to control the dissemination of research results (See post here.)

But the popularly elected alumni board members soon ran into opposition.

Perhaps sensing that a critical mass was building, Dartmouth's establishment then tried to skew the petition trustee process. The details are complex and tedious, but last autumn they cooked up a new alumni constitution that would have 'reformed' the way trustees were elected. In practice, it would have stacked the odds, like those in a casino, in favor of the house.

The measure needed two-thirds of alumni approval to pass, and in an election with the highest turnout in Dartmouth's history, it was voted down by 51%. 'It lost big time,' Mr. Rodgers says.

After the election of the fourth alumni reform trustee, things got worse,

A former trustee, and a current chair of Dartmouth's $1.3 billion capital campaign, publicly charged that the petition process had initiated a 'downward death spiral' in which a 'radical minority cabal' was attempting to hijack the Board of Trustees. That was among the more charitable commentaries.

And,

One of the main criticisms leveled at the petition trustee process is that it is polarizing, divisive and somehow detrimental to the college. Mr. Rodgers replies, 'If 'divisive' means there are issues and we debate the issues and move forward according to a consensus, then divisive equals democracy, and democracy is good. The alternative, which I fear is what the administration and [Board of Trustees Chairman] Ed Haldeman are after right now, is a politburo--one-party rule.'

And so, after losing four consecutive democratic contests, the Dartmouth administration has evidently decided to do away with democracy altogether. 'Now I'm working on the existence question,' Mr. Rodgers notes mordantly.

Though he cannot say for sure--'I'll be kept in the dark until a couple of days before the meeting on what they're planning on doing'--a five-member subcommittee, which conducts its business in secret and includes the chair and the president, has embarked on a 'governance review' that will consolidate power. 'It looks like they're just going to abandon, or make ineffectual, the ability of alumni to elect half the trustees at Dartmouth,' Mr. Rodgers says.

He believes that the model is the Harvard Corporation, where a small group 'makes all the decisions. They elect themselves in secret. They elect themselves in secret for a life term. How's that for democracy?'

Rogers noted the likely consequences of the "reform" that would prevent the popular election of any more reform candidates,

The alternative remedy, he continues, is poor corporate governance, for one. 'This is committees working in secret, which is a very bad way to run any organization.' Besides transparency, it may also present conflicts of interest, in which the college president would dominate those who ultimately evaluate his performance.

By the way, what does Rogers expect will happen after the publication of the WSJ article?

Mr. Rodgers expects to be 'severely criticized, unfairly and personally,' for talking to The Journal. He may even be removed from his post entirely.

It is upsetting that the representativeness, accountability, and transparency that partially characterizes Darthmouth's governance model is under threat.

The troubles at Dartmouth, however, should also underline how little representativeness, accountability, and transparency characterize the government of any US university or medical school. As noted earlier, most university boards of trustees elect themselves. The reasons particular people are chosen for board service, and their positions on policy issues relevant to their institutions are generally unknown. The boards' deliberations are generally secret.

If any university faculty members, alumni/ae, or students in the audience can tell me their universities operate differently, I would love to hear about it. (And if those universities include medical schools, I would be happy to publicize their better governance models.)

Meanwhile, it is reasonable to hypothesize that the mismanagement and mission-hostile management that too often is found at US (and other countries') academic medical institutions is due in part to institutional governance that is unrepresentative, unaccountable, and opaque.

And instead of seeing movement toward representativeness, accountability, and transparency, at one of the few schools that has a somewhat better governance model, we see moves by the administration in the wrong direction.

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